Key result
Compared to controls, patients with repaired atrioventricular septal defects had lower median z scores at the aortic annulus (-0.64 vs 0.60; P<0.001) and subaortic areas (-1.48 vs 0.59; P<0.001).
Why the study?
LVOT obstruction is a recognized risk after AVSD repair, but quantitative assessments to define the substrate of the obstruction are lacking.
Does atrioventricular septal defect repair result in abnormal left ventricular outflow tract morphometrics compared to matched controls?
Observational (n=167)
Does atrioventricular septal defect repair result in abnormal left ventricular outflow tract morphometrics compared to matched controls?
Absolute Event Rate: -1.48% vs 0.59%
p-value: p=< 0.001
Patients with AVSD demonstrate abnormal LVOT morphometrics early postoperatively compared to controls, which may be influenced by intrinsic morphology and repair techniques.
Abnormal LVOT z-scores after AVSD repair may warrant monitoring; leaves open whether intrinsic morphology or technique predominates.
OBJECTIVES: Although left ventricular outflow tract (LVOT) obstruction is a recognized risk after atrioventricular (AV) septal defect (AVSD) repair, quantitative assessments to define the substrate of the obstruction are lacking. METHODS: Morphometric analyses were based on measurements from early 2-dimensional echocardiographic scans (within 3 months postoperatively) for 117 patients (82 CAVVO = common AV valve; 35 SAVVO = separate AV valve orifices), which were compared to 50 age/weight matched controls (atrial septal defect/ventricular septal defect). Late echocardiographic analyses were performed in 57 patients with AVSD (follow-up range, 1.2-10.7 years). RESULTS: Adequate z scores (above -2.5) were observed in 109 (93%) patients with AVSD at the aortic annulus and in 89 (76%) with AVSD in the subaortic area. Compared to the control group, patients with AVSD had lower median z scores at the aortic annulus (-0.64 vs 0.60; P < 0.001) and the subaortic areas (-1.48 vs 0.59; P < 0.001), disproportionate subaortic/aortic annulus ratio <1.00 (67% vs 22%; P < 0.001), narrower annuloaortic-septal angle (94.0 vs 104.0; P < 0.001) and annuloaortic left AV valve angle (78.0 vs 90.0; P < 0.001). Compared to patients with CAVVO, those with SAVVO had narrower annuloaortic-septal angles (P = 0.022) that persisted at late analysis, with lower subaortic/aortic annular ratios (P = 0.039). In patients with CAVVO, lower early postoperative subaortic z scores were found following modified single-patch repairs (median -2.12 vs -1.02 in two-patch repairs; P = 0.004). A total of 6/117 (5%) patients (4 CAVVO, 5% and 2 SAVVO, 6%) required reoperations for LVOT obstruction (mean 6.9 years postoperatively), with no difference in morphology or types of operations. CONCLUSIONS: Despite having adequate z scores, patients with AVSD demonstrated abnormal LVOT morphometrics early postoperatively. Besides intrinsic morphology, repair techniques may have an impact on postoperative LVOT morphometrics and requires further evaluation.
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Chandiramani et al. (2021) conducted an observational in Atrioventricular septal defect (n=167). Atrioventricular septal defect vs. Age/weight matched controls was evaluated on Median z score at the subaortic area (p=< 0.001). Compared to controls, patients with repaired atrioventricular septal defects had lower median z scores at the aortic annulus (-0.64 vs 0.60; P<0.001) and subaortic areas (-1.48 vs 0.59; P<0.001).
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